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Friday, January 15, 2016

Death

The following speech was given by Per Fugelli at the conclusion of the Per Fugelli Lecture, delivered by Andy Haines at the University of Oslo, Oslo, Norway, on Dec 15, 2015.

Colleagues, friends—

I will now present to you: “The contribution of death to planetary health.” This may seem a strange thing to do. Here is my excuse. I have lived with the patient Per for 6 years now, with new cancers coming to the lungs and being carved out every year. Current condition? Myriads of metastases in both lungs. Dancing with death is not pleasant, but it is a discovery channel. I have used this pre-mortem time to explore the potential of death—for life. Here is my prescription.

Potential 1. The awareness of being mortal can enhance a person's moral stamina.

Potential 2. Remember you shall die, which may inspire you to use life for essential matters.

Potential 3. Awareness of death stimulates you to raise your eyes from the microscope to the horizon, from the particle to the whole. Not to be blindfolded for the individual patient, but to oscillate our clinical gaze between the sick person and the salutogenic or pathogenic world he or she is interconnected with.

Potential 4. Death may help medicine move from hubris to humility—from an illusion of being all mighty to a reconciliation with being “doctors with borders”—acting within finite technical, human, and planetary boundaries. Death demonstrates the fragility of life and the limitations of medicine. We ought to respect, not provoke the masters of planetary health: nature—and perhaps gods.

Potential 5. And now we come to the real thing: death is a sine qua non, a prerequisite for life. Without death, planetary health will fall into steep decline. All biological beings must die to create room for new life. A thought experiment: death leaves Oslo. Nobody dies. No birds, no flies, no bacteria, no humans, no flowers, no rats—in a short time Oslo will transform into an ecological hell. So death, my friends, is an act of solidarity with the future. Timely death is the best doctor for the Patient Earth. So nature and future demand our bodies to die. But spirit must not die. Hopes, values, dreams—are forever, guarded and conveyed by the ancestor spirits.

As a young medical student, Dr Zhivago, in Boris Pasternak's novel, is comforting his dying aunt: “You in others—this is your soul. You have always been in others and you will remain in others.” Medicine, the collective body of doctors, does have a soul. A soul expressed by Dr Bernard Lown when he received the Nobel Peace Prize on behalf of International Physicians for the Prevention of Nuclear War: “It may be argued that nuclear war is a social and political issue and we may address it only as concerned citizens. But we physicians have taken a sacred and ancient oath to assuage human misery and preserve life. This commitment imposes social and moral obligations for us to band together to make our collective voices heard.”1

Colleagues, I have no God, but I do have Saints, the eternal values of medicine: do good, be just, respect nature.